Michael Palmer: The Last Surgeon

“Hanging in there. The class is a nice distraction-especially these guys-but that nightmare I had on the way here is still resonating. Good thing I don’t have to hold a full cup of hot coffee.”

“Have you tried your eye exercises?”

Nick kissed her on the forehead and motioned to the examining room.

“I’m doing fine. Now, let’s go kick some mononucleosis butt.”

Not surprisingly, Junie was spot-on in her assessment of the seventeen-year-old, whose residence was listed as the 24 Hotel-night-by-night cots for homeless men. With no major trouble swallowing, and no striking enlargement of his spleen, the youth was sent out with a “mono sheet” of do’s and don’ts. As with most of their patients, the caregivers could only hope that he kept his follow-up appointment.

Nick was back giving final instructions to his class when the mono patient passed by them and left, followed moments later by Junie, carrying her umbrella.

“I’m going to grab the next victim,” she said. “I’m thinking of stopping by Dunkin’ Donuts across the street to see if they can donate a Box O’ Joe to our waiting room out there. They’ve done it before.”

“Like they have a chance against you.”

A gust of chilly, wet air blew in as she opened and closed the passenger side door.

Just a few minutes later, the door opened again and a short, stocky, balding man entered. He was wearing a tan trench coat and shaking off an umbrella. He was followed immediately by Phillip MacCandliss.

“Good evening, Garrity,” MacCandliss said, fixing Nick with dark narrow ferret eyes. “May I introduce Mr. Janus Fielding.” He increased his volume so that anyone in the rear of the RV could hear. “He’s with the D.C. Department of Health.”

The sight of MacCandliss turned Nick’s stomach. It wasn’t the first unannounced visit he had made to the RV-two other times over the past few years he had “just stopped by to see what this operation is all about.” But this was the first time he had arrived accompanied.

“We’re very busy, MacCandliss,” Nick said. “Why didn’t you phone ahead for an appointment?”

“Now that wouldn’t be a very good way to go about holding a surprise inspection, would it?”

The VA claims evaluator, infamous among the GIs for his hard-nosed refusal to grant disability benefits, remained in the stairwell behind Janus Fielding. MacCandliss was swarthy and thinly built, and looked slightly ridiculous in a tweed walking cap, but Nick knew better than to take the man lightly. He was devious and unpredictable except in his unswerving drive to put himself first in any situation.

Nick sized up the moment and considered whether it was worth stalling until Junie’s return. Still shaky, he wondered if he could control his temper, which was known to be hair-trigger when he was dealing with the confounding symptoms of his PTSD. He glanced out at the bus stop waiting area, but she was probably still in Dunkin’.

Damn you, MacCandliss , he barely kept from hollering out, why tonight?

“Okay, Mr. Fielding,” Nick said instead, sighing audibly, “why don’t we start at the beginning. Credentials?”

Fielding flipped open a dedicated leather case, revealing a Health Department badge and a photo ID.

Facilities Inspector, Department of Health.

“Exactly what is it you want, Mr. Janus Fielding?” Nick asked, recalling from a mythology course at Stanford that Janus was the Roman god of, among other things, doors and gates, and wondering how the man’s parents could have come up with so prophetic a name.

“I have a list of complaints that have been filed against this medical facility, of which you are the owner.”

“I’m assuming Mr. MacCandliss there is responsible for the complaints.”

“The forms are all in order,” Fielding said, pointedly ignoring the statement.

Behind him, MacCandliss was the very essence of smug.

“You know, we’re very busy,” Nick said, gesturing to the three men in the dining area, and out the window toward the bus stop.

Through the unremitting rain, he could see Junie approaching the shelter, carrying a large plastic bag and two ten-cup cartons of coffee. No surprise. Even if the staff at Dunkin’ was resistant, which they had never been in the past, they were outmatched.

“To begin with,” Fielding said, “I’d like to do a walk-through and conduct an inspection of the way you are handling issues of cleanliness, as well as your equipment and pharmaceuticals. I am especially interested in assurance that the needles and syringes are properly locked.”

“There’s really only room for one of you,” Nick said. “I’d appreciate it if Mr. MacCandliss stayed where he is, or better still, waited outside with the others.”

Over the next few minutes, Fielding made his way down his checklist, without finding anything major amiss. He did suggest that the isopropyl alcohol swabs be kept locked with the syringes and needles, and that the file drawers holding the patient records be doubly protected against both theft and fire. Right from the beginning Nick could tell he was reaching.

Bless you, Junie , he thought, reflecting on the thoroughness with which she insisted they prepare the RV.

Fielding was certifying that the sharps disposal units and the trash receptacles were to code when the front door swung open. A thin, unshaven white man in a sodden peacoat entered and squeezed past MacCandliss, who took a decent soaking and looked as if being closer than a city block away from the fellow was too close. The man, whom Nick recognized from other visits, headed unsteadily toward the aft examining room. He was followed closely by Junie, who made enough eye contact with Nick to say several things at once, the most important of which was that she was worried about this latest patient.

Nick felt the same way. The man, who Nick recalled was named Campbell, looked sick. His eyes were dark hollows and he had an odd tick at the corner of his mouth. Nick watched as Junie followed Campbell to the examining room. Then she turned at the last second and glanced back.

Don’t wait long , she silently urged.

Nick ushered Fielding back to where MacCandliss was waiting.

“Okay, guys, looks like I’ve got some doctoring to do. Feel free to wait… or not. Mr. Fielding, I can save you some trouble by telling you that we read the HIPAA manual as a bedtime story and that our board of directors makes surprise inspections of the RV all the time. Tell whoever filed complaints against us that they’re wasting their time and yours. I’ll be back when I’m sure this man is okay.”

Without waiting for a response, Nick headed to the examining room. Campbell, who smelled like the streets, was still standing, shifting from one foot to the other. Had there been much more room, he certainly would have been pacing. His eyes, pupils wide, were darting from one side of the space to the other.

“Mike,” Junie said, “sit down and let me get your coat off. I need to check your blood pressure. Nick, this is Mike Campbell.”

“We’ve met. When was it, Mike, a year ago?”

“I don’t know,” Campbell mumbled.

It was an overdose of some kind. Nick felt almost sure of it.

“Mike, we want to help you. Give us a chance to help you. We’re on your side. Have a seat up here.”

Hesitantly, Campbell pushed onto the edge of the examining table. Junie was just beginning to help him off with his coat when Nick saw the wet stain six inches below his armpit.

“Glove,” he said simply, to the nurse.

Without asking for an explanation, Junie slipped on a pair of latex gloves. Campbell reluctantly allowed her to remove his coat. The left side of his white Redskins T-shirt was soaked with an expanding oval of blood. At the center of the stain was a two-inch slit.